Secondary prevention

 

Recommendations 5.4.1

A. All patients with stroke or TIA should have their blood pressure checked.  Treatment should be initiated and/or increased as is necessary or tolerated to consistently achieve a clinic blood pressure below 130/80, except for patients with severe bilateral carotid stenosis, for whom a systolic blood pressure target of 130-150 is appropriate

B. For patients aged 55 or over, and African or Caribbean patients of any age, antihypertensive treatment should typically be initiated with a long-acting dihydropyridine calcium channel blocker or a thiazide-like diuretic.  If target blood pressure is not achieved, an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin–II receptor blocker (ARB) should be added

C. For patients, not of African or Caribbean origin younger than 55 years, the first choice for initial antihypertensive therapy should be an angiotensin-converting enzyme (ACE) inhibitor or a low-cost angiotensin-II receptor blocker (ARB)

D. Blood-pressure lowering treatment should be initiated after stroke or TIA prior to hospital discharge or at 2 weeks, whichever is the soonest, or at the first clinic visit for non-admitted patients.  Thereafter, treatment should be monitored frequently and increased as necessary to achieve target blood pressure as quickly as tolerated and safe in primary care.  Patients who do not achieve target blood pressure should be referred for a specialist opinion

Sources 5.4.2

A Prepared by: British Cardiac Society 2005; Rothwell et al. 2003;Lakhan and Sapko 2009
B National Institute for Health and Clinical Excellence 2011; PROGRESS Collaborative Group 2001
C National Institute for Health and Clinical Excellence 2011
D National Institute for Health and Clinical Excellence 2011; Rothwell et al. 2007